CASES OF THE WEEK – “Extraction of the 2.5cm long, smooth metallic foreign body using cubed end forceps” by Dr. Ahmed ElMansoury, Consultant, Pulmonology, NMC Royal Hospital Sharjah

A 50 years old male was referred by a dentist for management of foreign body aspiration. The male was Obese Class III patient. His height - 163 cm, weight - 123 kg and BMI is 46.3. The patient had a short neck which made intubation very difficult. Patient was advised for CT Chest (Computed Tomography) and it showed longitudinal metallic foreign body (screw) measuring about 2.4 cm at left Inferior Lobar Bronchi and seen at Lateral Basal segment of left Lower Lobe. The patient was advised Bronchoscopy under general anesthesia. The extraction of the foreign body was difficult since the screw was smooth, longitudinal in shape and it slipped into sub segments which was not visualized by Bronchoscopy.

Since the Foreign body (screw) was radio opaque, it can be monitored by X-ray. After careful consideration and patient counselling, Paediatric Bronchoscope and Fluoroscopy was advised to expedite the extraction. Once the foreign body was visible using the Paediatric bronchoscope, the segment was marked by continuous suction to induce bleeding. The foreign body was at the 5th bronchus generation, a tertiary sub-segment from inferior Lingular Segment. A large adult Bronchoscope with working channel was introduced since the location of the foreign body was detected and marked. The dilatation of sub segment was done mechanically and by injection of saline. The extraction of the 2.5cm long, smooth metallic screw was completed using cubed end forceps. The patient was discharged after 4 hours and advised a follow-up after one week.